Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. This substudy from a large multicenter trial examines benefits and harms of perioperative aspirin in patients with prior PCI undergoing noncardiac surgery.

Persons with HIV infection are at increased risk for hepatitis B virus infection. In this study, the authors used a nationally representative cross-sectional survey to estimate the prevalence of hepatitis B vaccination among U.S. patients receiving medical care for HIV infection.

Programs designed to improve quality of care by paying medical practices according to measures of their performance might inadvertently contribute to health care disparities. This study estimated differences in practice performance associated with exposure to Medicare's Value-Based Payment Modifier. It also assessed the effect of adjustment for patient characteristics on performance differences between practices serving higher-risk and those serving lower-risk patients.

This systematic review of 38 studies compares the accuracy of the quick Sequential Organ Failure Assessment and the systemic inflammatory response syndrome criteria for prediction of in-hospital or 28- or 30-day mortality in adult patients with suspected infection.

Ideas and Opinions

Chronic traumatic encephalopathy has recently been the focus of extensive attention. This commentary addresses diagnosis, prevention, treatment, and financial compensation for patients with a history of head trauma and their families.

The most notable recommendation in the 2017 American College of Cardiology and American Heart Association hypertension guidelines is the reduced threshold for the diagnosis of hypertension, from ≥140/90 mm Hg to ≥130/80 mm Hg in the general population. This commentary discusses the guidelines and why they create as many questions as they answer.

Editorials

Graham and colleagues' post hoc analysis of the POISE-2 trial compared outcomes when aspirin was continued in the subgroup of patients with a history of previous PCI who had noncardiac surgery. The editorialists discuss the implications of the findings for perioperative care of patients with prior PCI.

Roberts and colleagues found that the Medicare Value-Based Payment Modifier, which measures quality and costs among physician group practices and provides bonuses or levies penalties accordingly, had no beneficial effect on the quality or cost of care. The editorialists discuss why these findings show us that it is time to abandon stand-alone pay-for-performance programs as an approach to improve care.

Fernando and colleagues' review compared the prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA) and the systemic inflammatory response syndrome (SIRS) criteria for identifying patients with sepsis. The editorialists discuss the confusion surrounding sepsis scores and note that neither qSOFA nor the SIRS criteria are diagnostic for infection or sepsis, but they do offer information on the host's inflammatory reaction to an insult and the degree of physiologic perturbation.

O'Keeffe and colleagues' meta-analysis concluded that living kidney donors face elevated relative risks for end-stage renal disease, preeclampsia, and high diastolic blood pressure. The editorialists discuss the findings and believe that, despite the important contributions of this analysis, the field is still a long way from offering precise estimates to individuals about the risks surrounding kidney donation.

Mafi and colleagues report the findings of a qualitative study on having patients contribute to writing the note that documents what occurred in a health care encounter. The editorialist discusses the implications for patient-centered care and shared decision making.

As the field of hospital medicine moves into its third decade, it is worthwhile to reflect on the evolution of perioperative cardiovascular risk stratification and risk reduction measures, and to look toward the future.